The Moderating Role of Purging Behaviour in the Relationship Between Sexual/Physical Abuse and Nonsuicidal Self‐Injury in Eating Disorder Patients

This study sought to examine predictors of nonsuicidal self‐injury (NSSI) in eating disorder patients and to evaluate the moderating role of purging behaviours in the relationship between a theorised predictor (i.e. sexual/physical abuse) and NSSI. Participants in this study were 177 female patients with eating disorders (age range = 14–38 years) who completed semistructured interviews assessing eating disorder symptoms and eating disorder‐related risk factors (e.g. history of sexual and physical abuse, history of NSSI and feelings of fatness). Results revealed that 65 participants (36.7%) reported lifetime engagement in NSSI, and 48 participants (27.1%) reported a history of sexual/physical abuse. Early onset of eating problems, lower BMI, feeling fat, a history of sexual/physical abuse and the presence of purging behaviours were all positively associated with the lifetime occurrence of NSSI. The relationship between sexual/physical abuse before eating disorder onset and lifetime NSSI was moderated by the presence of purging behaviours, such that the relationship was stronger in the absence of purging. These findings are consistent with the notion that purging and NSSI may serve similar functions in eating disorder patients (e.g. emotion regulation), such that the presence of purging may attenuate the strength of the association between sexual/physical abuse history (which is also associated with elevated NSSI risk) and engagement in NSSI behaviours. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

The Role of Non‐suicidal Self‐Injury and Binge‐Eating/Purging Behaviours in the Caregiving Experience Among Mothers and Fathers of Adolescents with Eating Disorders

This study investigated the caregiving experiences of mothers and fathers of restrictive and binge‐eating/purging eating disordered (ED) inpatients with and without non‐suicidal self‐injury (NSSI). Sixty‐five mothers and 65 fathers completed the Experience of Caregiving Inventory. All inpatients completed the Self‐Injury Questionnaire—Treatment Related to assess NSSI and the Eating Disorder Evaluation Scale to assess eating disorder symptoms. Mothers reported significant more negative and more positive caregiving experiences compared with fathers. Mothers (but not fathers) of restrictive ED patients reported more positive caregiving experiences compared with mothers of binge‐eating/purging patients. The presence of NSSI in ED patients was associated with more negative caregiving experiences of both parents. Mothers and fathers of ED inpatients differ in caregiving experiences, and both binge‐eating behaviours and NSSI negatively affect their caregiving experience. Therefore, supportive interventions for parents of ED patients are necessary, especially of those patients who engage in NSSI. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Self‐care versus self‐harm: piercing,tattooing, and self‐injuring in eating disorders

Eating disordered patients seem to have a love–hate relationship with their bodies. Why do some decorate their bodies by means of tattooing and piercing, while others deliberately injure themselves and make parts of their body unattractive? We have explored this question in 101 eating‐disordered patients by means of self‐reporting questionnaires about the presence and characteristics of tattooing, piercing and self‐injuring as well as the underlying motives. Furthermore, we studied the co‐occurrence of impulsive behaviours as well as personality traits. In our patient sample, 11.9 per cent had one or more tattoos, 25.7 per cent a piercing and 64.9 per cent showed some form of self‐injurious behaviour (SIB). Tattooing and piercing are clearly driven by esthetical reasons, whereas SIB can have various explanations. All three behaviours were significantly more often linked to substance (ab)use. With respect to personality traits, piercing was positively linked to extraversion (positive affectivity) and openness, and negatively to conscientiousness. SIB, on the contrary, was positively linked to neuroticism (negative affectivity) and conscientiousness, and negatively to extraversion and openness. Tattooing did not show significant correlations with particular personality traits (probably due to the small number of tattooed patients). In summary, piercing and tattooing seem to reflect more self‐care, and might protect some patients against more self‐harm. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.     

Binge eating disorder and non‐purging bulimia: more similar than different?

There is evidence of an overlap of symptoms between binge‐eating disordered (BED) and bulimia nervosa non‐purging (BN‐NP) patients. In addition, there are indications of an evolution from bulimia nervosa to BED along a continuum of vulnerability. However, DSM‐IV categorizes BED and BN‐NP as distinct disorders based on clinical characteristics. In this study weight history and personality‐related characteristics (TCI; Cloninger, Svrakic, & Przybeck, 1993) were studied in 30 BED and 17 BN‐NP patients. BED patients were older, and had a longer duration of illness, a larger weight cycling, a higher current and previous BMI and a lower score for the temperament dimension ‘Persistence’ than BN‐NP patients. After correcting for age, differences between weight variables remained, including comparatively higher BMIs and larger weight fluctuations among the BED patients. A possible explanation is that this difference is due to a genetic effect of the propensity to be overweight and the temperamental characteristic of Persistence. This ‘morbid’ starting position and the lack of controlling mechanisms are associated with a more trait‐ than state‐dependent condition. Thus, restrained eating is not to be regarded as eliciting bingeing in BED patients. Due to personality characteristics these patients are not able to restrain, which clearly differentiates them from BN‐NP patients. Copyright © 2004 John Wiley & Sons, Ltd and Eating Disorders Association.     

Putative Risk Factors for Non‐Suicidal Self‐Injury in Eating Disorders

Evidence suggests a common association between eating disorders (EDs) and non‐suicidal self‐injury (NSSI). The present study aimed to investigate the potential risk factors for NSSI among ED patients. We assessed 245 ED patients with the Oxford Risk Factor Interview for ED. The results showed that 33% of ED patients reported NSSI in their lifetime. NSSI appeared to occur more frequently among binge eating/purging type ED patients than among patients with other ED and to be related to a more severe eating pathology. A younger age at the onset of eating problems, more negative self‐evaluation, suicide attempts, substance abuse, parents' low weight, family tension at mealtime, parental alcohol problems, childhood abuse, peer aggression, and negative antecedent life events were more common among patients with co‐occurring EDs and NSSI than among patients without NSSI. The results may inform the risk assessment and treatment of NSSI in EDs in the early detection period. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.     

The Role of Non‐Suicidal Self‐Injury and Binge‐Eating/Purging Behaviours in Family Functioning in Eating Disorders

This study aimed to investigate family functioning of restrictive and binge‐eating/purging eating disordered adolescents with or without non‐suicidal self‐injury (NSSI), as perceived by the patients and their parents (mothers and fathers). In total, 123 patients (between 14 and 24 years), 98 mothers and 79 fathers completed the Family Assessment Device. Patients completed the Self‐Injury Questionnaire‐Treatment Related and the Symptom Checklist 90‐Revised. No main effects were found of restrictive versus binge‐eating/purging behaviour nor of presence/absence of NSSI. For the parents, a significant interaction between binge‐eating/purging behaviour and NSSI emerged: Mothers and fathers reported worse family functioning in the binge‐eating/purging group in presence of NSSI, whereas mothers reported worse family functioning in the restrictive group without NSSI. Parental perception of family functioning is affected by the combined presence of binge‐eating/purging behaviour and NSSI. This finding should be taken into account when treating families living with eating disorders. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

Early Maladaptive Schemas in Eating Disordered Patients With or Without Non‐Suicidal Self‐Injury

This study investigates early maladaptive schemas (EMSs) in function of eating disorder (ED) subtypes (restrictive/bulimic) and the presence/absence of non‐suicidal self‐injury (NSSI). Female inpatients (N = 491) completed the Young Schema Questionnaire and the Self‐Injury Questionnaire. The influence of ED subtype and the presence/absence of NSSI and their interaction on the EMS were investigated by means of a MANCOVA. The results showed main effects of ED subtype and the presence of NSSI on EMS. Patients with bulimia scored significantly higher on insufficient self‐control and emotional deprivation, which are more related to cluster B compared with restrictive patients, whereas restrictive patients scored significantly higher on social undesirability, failure to achieve, subjugation and unrelenting standards compared with patients with bulimia that are more related to cluster C. Patients with ED with NSSI reported significantly higher EMS levels compared with patients without NSSI, suggesting that they could be of particular interest to benefit from schema therapy. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.     

Cross‐cultural assessment of eating disorders: psychometric properties of a Spanish version of the Bulimia Test‐Revised

The purpose of this study was to examine the psychometric properties of a Spanish version of the Bulimia Test‐Revised (BULIT‐R). The goal was to test the factor‐structure equivalence of the BULIT‐R across two samples of college students from two different cultures, Spain and the US. Researchers using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) have reported different model solutions for the factor‐structure of the BULIT‐R: a one‐factor model, a four‐factor model, a five‐factor model and a six‐factor model. For the two samples, CFA did not support any of the models previously reported in the literature. EFA supported a six‐ and a four‐factor models for the US and Spanish samples, respectively. © 2007 John Wiley & Sons, Ltd and Eating Disorders Association.     

Evaluation of a Motivation and Psycho‐Educational Guided Self‐Help Intervention for People with Eating Disorders (MOPED)

High dropout rates and poor levels of engagement are well documented for patients with eating disorders. Utilising motivational techniques and providing psycho‐education have been suggested as ways to reduce treatment disengagement. This study aimed to evaluate the effect of a newly developed motivational and psycho‐educational (MOPED) guided self‐help intervention for people with eating disorders on engagement and retention in therapy. Patients who received MOPED pre‐treatment (n = 79) were compared with a diagnosis‐matched group of patients receiving treatment as usual (TAU; n = 79). The study found that patients receiving MOPED had a higher engagement rate than those within the TAU group. Specifically, patients in the anorexic spectrum were found to present with both higher rates of engagement and completion of therapy when issued with MOPED in comparison with TAU. Self‐help packages using motivational style could be a valuable and cost‐effective intervention for patients with eating disorders. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.     

Naturalistic outcomes for a day‐hospital programme in a mixed diagnostic sample of adolescents with eating disorders

Despite initial data suggesting positive treatment outcomes for adolescent eating disorder day‐hospital programmes (DHPs), existing studies have included limited follow‐up, small samples, and a focus on restricting‐type eating disorders. To address these gaps, we explored naturalistic outcomes for an adolescent eating disorders DHP. Adolescent participants (N = 265) completed measurements at treatment admission, discharge (n = 170), and various lengths of follow‐up (n = 126; M_{follow up} = 278.87 days). Results from multilevel models indicated significant increases in body weight for the anorexia nervosa group throughout treatment and maintenance of increased body weight from discharge to follow‐up. In bulimic spectrum disorders, binge eating and purging significantly decreased from intake to discharge and did not change from discharge to follow‐up. Across the entire sample, eating disorder symptoms decreased from intake to discharge and did not change from discharge to follow‐up. Further, anxiety and depression decreased over the course of treatment and continued to decrease over the follow‐up period. The current investigation represents the first study to explore longitudinal DHP outcomes within adolescent bulimic spectrum eating disorders. Our findings also highlight many challenges inherent in conducting naturalistic research; it is critical that the field continue to develop solutions to the barriers inherent in conducting longitudinal research on eating disorder treatment.     

Self‐Discrepancy and Eating Disorder Symptoms Across Eating Disorder Diagnostic Groups

This study examined self‐discrepancy, a construct of theoretical relevance to eating disorder (ED) psychopathology, across different types of EDs. Individuals with anorexia nervosa (AN; n = 112), bulimia nervosa (BN; n = 72), and binge eating disorder (BED; n = 199) completed semi‐structured interviews assessing specific types of self‐discrepancies. Results revealed that actual:ideal (A:I) discrepancy was positively associated with AN, actual:ought (A:O) discrepancy was positively associated with BN and BED, and self‐discrepancies did not differentiate BN from BED. Across diagnoses, A:O discrepancy was positively associated with severity of purging, binge eating, and global ED psychopathology. Further, there were significant interactions between diagnosis and A:O discrepancy for global ED psychopathology and between diagnosis and A:I discrepancy for binge eating and driven exercise. These results support the importance of self‐discrepancy as a potential causal and maintenance variable in EDs that differentiates among different types of EDs and symptom severity. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.     

An Adjunctive Multi‐family Group Intervention with or without Patient Participation during an Inpatient Treatment for Adolescents with an Eating Disorder: A Pilot Study

This study reports on a pilot study of a family group intervention with or without patient participation adjunctive to a specialized inpatient treatment for eating disorders (EDs). Participants were 112 female adolescent ED inpatients and one or both of their parents. The parents were invited to participate in an adjunctive multi‐family group with patient (MFT) or in a similar multi‐parent group without patient participation (MPT). Questionnaires assessing ED symptoms, family functioning and caregiving experiences were administered before and after intervention. Post‐intervention results obtained from both patient and parent(s) indicated that improvement in ED symptoms and parental burden occurred after both types of interventions. Family functioning improved differently according to the informant: fathers reported an improvement of general family functioning, patients reported an improvement of problem solving and mothers reported a decrease in problem solving across both formats. This study emphasized the importance of including a multi‐informant approach in family interventions. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.